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Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital malformation of the urogenital tract involving both the müllerian and the wolffian ducts, and it consists of the association of didelphys uterus, ipsilateral obstructed hemivagina, and ipsilateral kidney agenesis. Its etiology is related to the abnormal development of two embryonic structures—mesonephros and paramesonephros—although its precise mechanism is not known, but theories involving signaling molecules and gene expression are studied for potential explanations. Because of its rarity, there is limited literature on this subject. We present a case diagnosed in our department and elaborate on management. In HWW syndrome, symptoms appear after menarche and include pelvic pain, with progressive intensity due to the developing of hematocolpos. Menstruation may be present or absent depending on the type of anomaly. The use of magnetic resonance imaging (MRI) is the most recommended method of investigation since, in most cases, at this age, sexual life has not started yet and transvaginal ultrasound cannot be used. Surgical treatment in our case consisted of an exploratory laparoscopy followed by a vaginal surgical approach to resect the vaginal septum of the obstructed hemivagina. [ABSTRACT FROM AUTHOR]

Management strategies for pregnancies with abnormal adherence/invasion of the placenta (placenta accreta spectrum, PAS) vary between centers. Expectant management (EM), defined as leaving the placenta in situ after the delivery of the baby, until its complete decomposition and elimination, has become a potential option for PAS disorders in selected cases, in which the risk of Caesarean hysterectomy is very high. However, expectant management has its own risks and complications. The aim of this study was to describe the rates of subsequent hysterectomy (HT) in patients that underwent EM for the treatment of PAS disorders. We reviewed the literature on the subject and found 12 studies reporting cases of HT after initial intended EM. The studies included 1918 pregnant women diagnosed with PAS, of whom 518 (27.1%) underwent EM. Out of these, 121 (33.2%) required subsequent HT in the 12 months following delivery. The rates of HT after initial EM were very different between the studies, ranging from 0 to 85.7%, reflecting the different characteristics of the patients and different institutional management protocols. Prospective multicenter studies, in which the inclusion criteria and management strategies would be uniform, are needed to better understand the role EM might play in the treatment of PAS disorders. [ABSTRACT FROM AUTHOR]

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Systemic lupus erythematosus (SLE) is common in women of reproductive age and can have serious consequences on pregnancy outcomes. Recent updates in the clinical management of this condition have brought improvements for mothers affected and their babies. The aim of this general review is to offer the perspective of the maternal-fetal medicine specialist on the recent updates in clinical management of SLE in pregnancy and to bring into the attention of the rheumatology specialists the tools that obstetricians have nowadays in monitoring high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: We present the results of the systematic application of the first trimester combined test for aneuploidies, in a Romanian center.Methods: Since October 2009, in Filantropia Hospital in Bucharest, we have systematically been using the FMF (Fetal Medicine Foundation) combined first trimester test to screen for common aneuploidies at 11 to 13 + 6 weeks of gestation. We assessed the crown to rump length (CRL), nuchal translucency, fetal heart rate as well as PAPP-A, and free β-hCG in maternal serum. We evaluated additional first trimester ultrasound markers in most of the cases. The individual risk for aneuploidies was calculated using the FMF algorithm.Results: Pregnancy outcome is known for 6030 euploid fetuses and 42 aneuploid fetuses from our screening population. The detection rate for trisomy 21 of the combined test was 87.5% for a screen positive rate of 1.96%. All of the trisomy 18 and trisomy 13 cases were detected prenatally. Some of the trisomy 18 cases proved not to be symptomatic in the first trimester.Conclusions: Our results are similar to those of the main studies on the FMF method of first trimester screening for aneuploidies. Our numbers are small because of limited availability of the very specialized resources involved. [ABSTRACT FROM AUTHOR]

This article presents the case of a 54-year-old woman who presented with a sudden fever and erythema on the right breast and right arm and the right side of her back. There was no history of trauma, but 11 months earlier she had undergone a wide local excision with axillary lymph-node dissections for an invasive ductal carcinoma of the ipsilateral breast. She did not get perioperative antibiotic treatment. She also had undergone chemotherapy on the right breast. Examination of the breast showed no masses nor did ultrasonography. A diagnosis of cellulitis was made and the patient recovered fully following a course of oral antibiotics.

The rupture of an unscarred uterus in pregnancy may result in catastrophic consequences for both mother and baby. This is usually related to a delayed diagnosis and treatment, because of a low index of suspicion. There have been described a series of risk factors incriminated in unscarred uterine rupture, such as abdominal trauma, labor induction, obstructed or neglected labor, and operative vaginal deliveries. Although it is a rare event that happens more often in old multiparous patients, there have been reported cases of uterine rupture in primiparous women. A uterine rupture is an unpredictable event that happens suddenly, can have dramatic, but non-specific symptoms, and requires a high index of suspicion and prompt management to reduce maternal and neonatal morbidity and mortality. The purpose of this study is to synthesize available information about the rupture of the unscarred uterus, its risk factors, diagnosis, and management. [ABSTRACT FROM AUTHOR]

This review has the purpose to evaluate and report clinical characteristics, treatment, and obstetric outcomes of adnexal torsion in pregnant women in order to raise awareness of the need for prompt diagnosis and surgical intervention. Adnexal torsion (AT) in pregnancy is a rare event but is a surgical emergency that needs prompt intervention. Misdiagnosis or delay in treatment can lead to loss of ovarian function with an effect on future fertility and loss of the pregnancy. The use of assisted reproductive technology is associated with an increased risk of AT. Diagnosis of AT is very challenging due to its nonspecific signs and symptoms such as abdominal pain, nausea, vomiting, and abdominal tenderness. Furthermore, pregnant women with AT present with specific characteristics, and these common signs and symptoms may be caused by other obstetric and non-obstetric conditions. Ultrasound examination may not be as valuable as in non-pregnant women. MRI can assist in making the diagnosis in pregnant women. Clinical suspicion of AT should not delay treatment if the imaging evaluation is not clarifying. In standard practice, the surgical treatment of AT is performed by laparoscopy which is safe for pregnant patients regardless of the trimester. The treatment is based on a conservative approach by preserving the adnexa although initially, the ovary may seem necrotic. During the intervention the adnexa is de-twisted, and cystectomy or cyst aspiration is performed, if any adnexal mass is present, to reduce the recurrence risk. Surgery during pregnancy for suspected AT does not lead to adverse obstetrical outcomes. Given the difficulties of the diagnosis of AT in pregnancy, it is of great importance that clinicians are familiar with this complication in pregnancy and are aware of the need for prompt intervention. [ABSTRACT FROM AUTHOR]

Skin cancer during pregnancy is common, with malignant melanoma being the most frequent and the most aggressive. Any pigmented skin lesion that suffers changes should be examined by a specialist and if considered high-risk, biopsy should be performed right away and not postponed as it is thought to be safe during pregnancy. Recent studies showed that it has the same outcome compared with the non-pregnant state, if diagnosed and treated as soon as possible. Diagnosis of skin cancer, including melanoma, does not necessarily require an early delivery or termination of pregnancy, if in the first trimester, except for pregnant patients with poor prognosis (advanced disease) that need more aggressive, systemic treatment. Management needs to be established in specialized centers with a multidisciplinary team. Monitoring should be performed by a team consisting of an obstetrician, a maternal-fetal medicine specialist, a neonatologist, and an oncologist. [ABSTRACT FROM AUTHOR]

Acute appendicitis is the most frequent non-obstetrical surgical emergency encountered in pregnancy with negative maternal and fetal outcomes, mostly attributed to appendicular perforation. The purpose of this article is to discuss the characteristics in diagnosing appendicitis in pregnancy, recommendations of management, as well as maternal and fetal outcomes. It is significantly challenging to diagnose appendicitis in pregnancy due to the anatomic displacement of the appendix caused by the enlargement of the uterus (which may cause uncommon symptomatology), the physiologic leukocytosis of pregnancy, the raised prevalence of abdominal discomfort along with the inability to perform computed tomography because of the radiation exposure of the fetus. These particularities may delay an accurate and timely diagnosis which is of utmost importance in order to avoid the significant complications associated with peritonitis. Rapid surgical intervention (especially laparoscopy) is recommended, nevertheless, the key in managing appendicitis in pregnant patients is finding a balance between the risk of delaying the diagnosis and consequent perforation against the risk associated with a negative appendectomy. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign tumors affecting female genital tract, responsible for a high morbidity across fertile age women, with a prevalence of 0,1-11% among pregnant women. Although generally asymptomatic, they can lead to a series of symptoms and complications such as pain, infertility, miscarriages, antenatal bleeding, postpartum hemorrhage, preterm labor, fetal malpresentation, placental abruptio and high cesarean section rates. The purpose of review is to update information regarding fibroids specifications and their correlation with pregnancy outcomes as well as fibroids management during pregnancy. Because of uterine fibroids heterogeneity and lack of large, randomized trials there are encountered discrepancies among studies, but it was observed that uterine fibroids increase the risks of negative obstetrical outcomes, especially when it goes to large, multiple, submucous and retroplacental myomas. Conservative management during pregnancy is advised, but in special situations myomectomy could be recommended and possible. Trial of labor should be offered to pregnant women even if they have large uterine fibroids, or previous myomectomy excepting fibroids obstructing the birth canal or patients who underwent extensive surgery for fibroids removal. [ABSTRACT FROM AUTHOR]

Acute intestinal obstruction in pregnancy is a rare, unusual, and very challenging non obstetric surgical pathology linked with great fetal-maternal morbidity and mortality. It is estimated that a surgeon may encounter and resolve 1 to 2 cases in his career. Bowel obstruction is difficult to diagnose because signs and symptoms such as pain, vomiting, abdominal distention, and constipation are frequently attributed to normal pregnancy. On the other hand, gravidity requires immediately, in case of suspicion of grave abdominal pathology, such as bowel obstruction, that surgery should not be delayed. [ABSTRACT FROM AUTHOR]

Acute pancreatitis in pregnancy is a rare, but severe medical condition, occurring in 1 in 1,000 to 1 in 10,000 pregnancies and may present as mild, moderate, or severe disease. Diagnosis of acute pancreatitis in the pregnant population is hampered by biochemical and hematological alterations generated by pregnancy itself. There is an increased risk of maternal and fetal complications in cases of severe acute pancreatitis in pregnancy. Diagnosis of acute pancreatitis in pregnancy is based on clinical examination, laboratory tests and imaging techniques. Endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography and endoscopic ultrasound are diagnostic and therapeutic modalities. Surgical treatment is indicated in severe and refractory cases of acute pancreatitis in pregnancy and laparoscopic cholecystectomy is preferred over open cholecystectomy. Timely diagnosis and management of acute pancreatitis significantly improves both maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Hemolytic disease of the fetus and newborn is a consequence of maternal immune response to fetal red blood cells antigens inherited from the father, that the mother does not possess, stimulated by antepartum or intrapartum fetomaternal hemorrhage. As a result, fetal erythrocytes are destroyed, leading to various degrees of anemia and hyperbilirubinemia, with high perinatal morbidity and mortality rates. This review's purpose is to reveal the importance of the alloantibodies beyond RhD and ABO system, the updated algorithms used in the diagnosis and management of the disease and the importance of RhD universal immune prophylaxis practice. For this purpose, the database from PubMed and UpToDate was searched for literature reviews, case studies, society guidelines and retrospective studies in English regarding hemolytic disease of the fetus and newborn from 2013 to March 2022. Anti D prophylaxis protocols, early diagnosis and proper intrauterine and postpartum treatment help significantly reduce the disease's burden. [ABSTRACT FROM AUTHOR]

Behçet’s disease is a multisystemic inflammatory chronic vasculitis of unknown etiology characterized by recurrent oral ulcers, genital ulcers, eye lesions, and dermatological manifestations that is usually diagnosed during the reproductive years. There is limited information about the effects of Behçet’s disease on pregnancy and vice versa, but in most women, it appears to improve during this period. However, cases of activation or exacerbation of the disease in pregnancy are not uncommon and they are mainly manifested by oral ulcers, genital ulcers, and skin lesions. Corticosteroids and topical sucralfate are safe to use in pregnancy and while breastfeeding to treat oral ulcerations. The purpose of this study is to synthesize available information about Behçet’s disease oral manifestations in pregnancy, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a clinical radiologic syndrome characterized by visual deficits, altered consciousness, headache, confusion, seizures and focal neurological signs. Its pathophysiology is still uncertain, with vasogenic edema being the most frequent incriminated mechanism. It was described in correlation with hypertensive encephalopathy, eclampsia, use of cytotoxic and immunosuppressive drugs and renal diseases. Regarding its association with pregnancy, it is important to deliver the baby as soon as possible, to administer proper medication for hypertension, with labetalol being first choice and combat seizures or any signs of status epilepticus. A clear diagnosis can be established by combining clinical presentation with imaging techniques, especially T2 images of MRI. It has a rapid progression and good prognosis is obtained by early recognition and prompt treatment of associate condition. [ABSTRACT FROM AUTHOR]

Although there has been various pandemics throughout the history of humankind, modern age was thought to be ready to face such a challenge by implementing an advanced health care system. However, epidemic outbreaks are ubiquitous, and they have a substantial potential to evolve into pandemics, hence this being the actual context of SARS-CoV-2 pandemics from 2019. The difficulty of the addressed subject consists in the fact that the majority of pharmacological clinical studies omited pregnant patients. Acknowledging the physiological changes, pregnant women represent an unique group of patients as pregnancy could embody a particular substrate for this contemporary type of infection. [ABSTRACT FROM AUTHOR]

Toxoplasmosis is the most common cause of congenital infection, causing long term ocular and neurological lesions with relapses during childhood and adolescence. The risk of congenital infection is highest after primary maternal infection with advancing maternal gestation. Only a few european countries recommend a routine prenatal screening although therapeutic options are the same. Primary prevention measures regarding food hygiene and secondary prevention through serological testing are the most important ways to prevent and detect toxoplasmosis during pregnancy. Counselling is challenging since there is a need for reference centers of diagnosis. In Romania there is a routine clinical practice to offer screening through the TORCH panel in the first trimester of pregnancy. This review summarizes the current methods of diagnosis and management of toxoplasmosis in pregnancy. [ABSTRACT FROM AUTHOR]